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Bone-Like Chips and Nodules Formed in Tissue Near Almost Healed Wound

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  • #16
    Broken doll any updates or answers about what's going on with your wound?


    Sorry I didn't see this earlier. I hope you haven't thrown in the towel yet. I'm at my wits end too because my daily life continues to spiral downwards but I'm still trying to find a solution. I’d really like to try PEMF but can’t find a wound doctor to support or utilize this type of therapy even though there is quite a bit of research on how electromagnetic therapy prevents HO in SCI and also heals stage III and IV wounds.

    Medicare covers the treatment in a clinical setting. Unfortunately, they will not purchase or rent the machine and mat for home use setting even though the recommended protocol is to lie on the mat twice a day for 3hours each session. (save this Medicare issue for another post).

    I hear you about being in a nightmare and a bevy of specialist doctors not being on the same page. No one wants to take my care's lead either leaving the responsibility for me to make decisions that I am not sufficiently knowledgeable to do so. Complicating the process more is that each specialist has a differing opinion and hardly anybody has heard of HO.

    No concrete diagnosis has been made for HO on my hip yet. I had an MRI in September that indicated extensive osteomyelitis. However, I didn't have any other infection symptoms, so the doctor suggested that HO can be a great mimicker and maybe I didn't have infection. He had also taken cultures of the bone fragments, but I don't know the results.

    Initially, I had a wound on my right trochanter that healed completely after a few months of lying in a 'dolphin air bed' and Wound Vac therapy. About a month later, August, I woke to find a reappearance of the wound - angry red inflamed. This time, the wound care doc started finding bone chips and crystals during his weekly debridement of the wound.



    I also started having fevers, chills, malaise and horrible right hip and radiating lower back pain. My ROM became severely restricted. I now have a very hard time sitting up in bed anymore when before I was extremely flexible in being able to bend at my waist and touch my toes. Some days are worse than others. Initially, I was in excruciating pain and given some Norco that helped a little.

    Now, three months later, I still have ROM limitations, but I'm not in constant pain. its becoming rare to find any crystals or bone fragments. Unfortunately, while the wound at the surface is the size of the end of a wooden tip stick, it has tunneled down to 4 cm. and the infection is in my bone. The wound became so small that the Wound Vac was discontinued two months ago. I have more drainage than ever though. The doctor is talking about making the hole bigger.



    At this point, the main priority is controlling the infection with 6-8 week IV antibiotics (Rocephen) and daily wound care management through home health nursing. My life has become consumed with medical maintenance. Home health wound dressings in the a.m., IV injections in the evening, weekly wound care, lab work, infectious disease and surgeon appointments and now physical therapy too.
    I saw an orthopedic surgeon who said there is no HO, only calcification. He confirmed the appearance of calcification occurring since 2011 in a series of X-rays to late 2014. He felt I should be aggressive and have surgery to remove the infection from the bone. Tomorrow I have a preop for this surgery scheduled on Dec. 17.


    I wish I knew the difference between calcification and heterotypic ossification. My understanding is that HO requires a doctor with a very good understanding of it and that if removed before maturity, it will spread. The last thing I want is to have even more HO and become completely frozen in my hips.

    Also, I would like more information to diminish the nagging fear that it could be HO that developed since 2014, maybe since April 2015 when I started seeing the wound doctor for wound treatment. I'm anxious to put this wound and its complications behind me, however, I'm very uncomfortable in following through with the surgery because all my doctors have different opinions.


    My spinal cord physiatrist felt it was latent HO - usually it occurs immediately after a SCI. I'm 30-years post. He felt that the trauma of a broken femur in 2011 set the HO off. I have been experiencing alignment issues ever since that fracture causing my posture to change and affecting my seating. Also my right hip rotates out affecting my transfers and ability to dress and other ADLs. He inferred that the weekly debridements may have exacerbated the HO causing it to increase production. His advice was to get the inflammation under control and let the wound doctor handle it. Also he felt physical therapy or my hobby, yoga, could make it worse and advised me to stop.

    My wound care doc believes HO is the more likely case, but he has never dealt with it before so is uncertain. He has never seen the calcification crystals or bone chips (up to the size of small teeth).

    My infectious disease doctor says it is just calcification and the bone chips are simply fragments from the degraded infected bone. He is anxious to treat the wound aggressively with surgery to remove the infected area of the bone.

    The plastic surgeon didn’t know what HO was. He said its calcification and he deals with it all the time. I have nothing to worry about. Eight months ago, he wanted to do a flap surgery on my initial wound when it was larger. Now, however, since the wound hole is almost closed, he feels it is unnecessary to go in there and doing so might cause a whole new sort of problems.


    I don’t know what to do.



    What’s the difference between having a plastic surgeon or an orthopedic do the surgery? The plastic surgeon would have me in the hospital 3 weeks; the orthopedic surgeon hospital stay is only 3 days.

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    • #17
      Is it possible for you to get a second opinion, both from the orthopedic surgeon and from the plastic surgeon? What surgery are these two proposing??

      (KLD)
      The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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      • #18
        I've received five opinions, varied but the consensus is an immediate need to stem the infection. The wound is like a pinhole on the surface but tunnels 4cm into what my wound doctor believes is a seroma cyst that continues to fill with fluid and create lots of drainage every day.

        The original wound opened in April 2015 and was healed in July. It reopened in August and started spewing out calcium crystals and bone chips. Also, my ROM starting getting more limited. I have a real hard time sitting up because my right hip holds me back. (Could that be from lying in bed too long or inflammation instead of HO?) In late September, osteomyelitis was suspected and confirmed by MRI in October.

        Since the opening is so small, the doctors agree that a flap surgery would be inappropriate since the infection is inside. The orthopedic surgeon said he'll go in and scrape out the infection and do cultures to determine if any other bacteria strains are in the tissue that need to be addressed and biopsies to determine any malignancy. Three days in the hospital vs. 3 weeks in skilled nursing for a flap.

        i still have a "what if" it was immature HO nagging me after reading in these forums how important it was to find the right surgeon and to make sure the bone was mature before removing it.

        What's the difference between calcification in the hip joint and HO? Does it look different on an X-ray?

        The ortho doc determined by an X-ray taken 2-years ago that it was only calcification and couldn't be HO. Dr. Stenjhem felt the HO could have been triggered from the trauma of the wound and the weekly debridement that was about 6 months after the last X-ray. Can I trust the ortho that his reading is correct?

        I read that HO is common in hip replacements which is something he does a lot of as a lower extremity ortho specialist, so am trusting his experience.

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        • #19
          The X-ray appearance would be different in terms of the location of the calcium deposits.

          Calcification in hip H.O. develops outside the joint ( extra-articuar ). Pockets of fluid inside the hip joint ( intra-articular ) can also develop calcifications but they're not defined as H.O.

          The Plastic Surgeon has likely dealt with calcifications developing in pockets of fluid called seromas that sometimes occur in soft tissue following cosmetic surgical procedures..
          Last edited by 2drwhofans; 12-05-2015, 10:29 PM.

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          • #20
            Thanks 2drwhofans

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            • #21
              Heal well.

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              • #22
                I am experiencing a similar situation with the tunneled wound(right ischial). This weird almost tear drop shaped structure is in the middle of the wound w 2 4cm tunnels branching off. Surgeon has said looks like a bone fragment w tissue formed around it, and wants to remove. I will ask about HO when i see him next.

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